Isolated systolic arterial hypertension: labile, stable

When the diagnosis is formulated as systolic arterial hypertension, this means that the arterial pressure in the systolic phase – the contraction of the heart – exceeds the physiological norm (and is at least 140 mm Hg), and the diastolic pressure (during relaxation of the heart muscle between contractions) is fixed at the level of 90 mm Hg.

This type of hypertension is more common in older people, especially women. In fact, most patients with hypertension over 60 years of age have isolated systolic hypertension.

The importance of systolic pressure was established by researchers in the 1990s, when it was discovered that diastolic blood pressure fluctuates less and that a risk factor for coronary heart disease and stroke is elevated systolic pressure, which increases throughout life.

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Epidemiology

According to statistics from the Ministry of Health of Ukraine, 12.1 million citizens have been diagnosed with arterial hypertension, which exceeds the 2000 figures by 37.2%.

Moreover, isolated systolic arterial hypertension in patients aged 60-69 years accounts for 40% to 80% of cases, and over 80 years – 95%.

As reported in the Journal of Hypertension, isolated systolic arterial hypertension in the elderly is a prognostic factor for the development of cardiovascular diseases even at a systolic blood pressure level of 150-160 mm Hg, which provokes complications of existing cardiac problems in a third of patients.

Hypertension is a major cause of morbidity and mortality due to its association with coronary heart disease, cerebrovascular disease, and renal failure. Studies have shown that hypertension is the primary pathogenetic factor in 500,000 strokes in patients in North America (half of which are fatal) and almost one million myocardial infarctions per year. In patients with high blood pressure, the cumulative incidence of first cardiovascular events over 10 years is 10% in men and 4.4% in women.

And data from NHANES (The National Health and Nutrition Examination Survey) indicate that systolic hypertension in young people (aged 20-30 years) has more than doubled in recent decades, to 2.6-3.2% of cases.

The prevalence of systolic hypertension in hyperthyroidism is 20-30%.

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Causes systolic arterial hypertension

The causes of systolic arterial hypertension established by clinicians are related to:

• with age-related decrease in the elasticity of large arteries due to the accumulation of fatty (cholesterol) deposits on the inner side of the vessel walls (atherosclerosis);
• with aortic insufficiency - a malfunction of the aortic valve of the heart (located at the exit of the aorta from the left ventricle);
• with granulomatous autoimmune arteritis of the aortic arch (Takayasu's aortoarteritis);
• with hyperaldosteronism (increased activity of the adrenal cortex and increased production of the hormone aldosterone, which contributes to an increase in the volume of circulating blood);
• with increased activity of the thyroid gland (thyrotoxicosis or hyperthyroidism);
• with kidney diseases, in particular, renal artery stenosis;
• with metabolic syndrome;
• with anemia.

In this case, systolic arterial hypertension in case of aortic valve insufficiency, aortic arch arteritis, hyperthyroidism or anemia is considered symptomatic or secondary.

Among the most common reasons for the development of systolic arterial hypertension in young people, experts name age-related hormonal changes. However, hypertension in young and middle age increases the risk of severe cardiovascular pathologies in the future.

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Risk factors

In the development of arterial hypertension, such risk factors as old age; physical inactivity; abuse of fats, salt and alcohol; high cholesterol in the blood; calcium deficiency in the body; diabetes and obesity play an important role.

The likelihood of systolic hypertension increases if blood relatives have the disease, since some features of blood pressure regulation are passed on through genes.

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Pathogenesis

The pathogenesis of the development of isolated systolic hypertension is explained by a number of disturbances in the complex process of regulation and control of arterial pressure – the result of cardiac output and systemic vascular resistance.

In arterial hypertension, either an increase in cardiac output or an increase in systemic vascular resistance, or both disorders simultaneously, can be observed.

Neurogenic control of blood pressure is carried out by the vasomotor center - a cluster of baroreceptors in the medulla oblongata, which respond to the stretching of the vessel walls, increasing afferent impulse activity. This, in turn, reduces efferent sympathetic activity and increases the tone of the vagus nerve, due to which the heart rate decreases and the vessels dilate. However, with age, the sensitivity of baroreceptors gradually decreases, which is a feature of systolic arterial hypertension in the elderly.

Blood pressure and the entire blood circulation process are also controlled by the renin-angiotensin system of the body. Under the influence of renin, an enzyme of the periglomerular apparatus of the kidneys, a biochemical transformation of the vasoconstrictor hormone angiotensin occurs into the inactive peptide angiotensin I. The latter, with the help of ACE (angiotensin-converting enzyme), is converted into the active octapeptide angiotensin II, which acts on specific receptors (AT1 and AT2) and causes narrowing of the lumen of blood vessels and the release of the corticosteroid hormone of the adrenal cortex aldosterone. In turn, an increase in the level of aldosterone in the blood contributes to an increase in the volume of circulating blood, an imbalance of sodium (Na+) and potassium (K+) ions in the blood, and an increase in blood pressure. This is what happens with hyperaldosteronism.

By the way, the release of renin also increases with stimulation of β-adrenergic receptors of the sympathetic nervous system by catecholamines (adrenaline, noradrenaline, dopamine), which are released in excess during excessive physical exertion; a prolonged state of psychoemotional overexcitation; increased aggression and stress; adrenal tumors (pheochromocytoma).

Atrial natriuretic peptide (ANP), which relaxes the muscle fibers of the walls of blood vessels, is released from the myocardial cells (cardiomyocytes) of the atria when it is stretched and causes the release of urine (diuresis), the excretion of Na by the kidneys and a moderate decrease in blood pressure. In case of problems with the myocardium, the level of ANP decreases and blood pressure increases during systole.

In addition, patients with this type of hypertension may have impaired function of vascular endothelial cells. The endothelium lining the vascular cavity synthesizes endothelins, the most powerful vasoconstrictor peptide compounds. Their increased synthesis or sensitivity to endothelin-1 may cause a reduction in the formation of nitric oxide, which promotes vasodilation – relaxation of the walls of blood vessels.

The pathogenesis of isolated systolic hypertension in hyperthyroidism is associated with the fact that the hormone triiodothyronine increases cardiac output and blood pressure at the moment of cardiac contraction.

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Symptoms systolic arterial hypertension

It should be taken into account that in a mild form, the symptoms of systolic arterial hypertension may manifest weakly and quite rarely - as a periodic feeling of heaviness in the head and/or pain in the back of the head, attacks of dizziness, tinnitus, restless sleep.

As the pathology progresses, the symptoms intensify, and attacks of more intense headaches and nausea, increased heart rate, shortness of breath and pain on the left side of the chest are added.

When the cause of increased blood pressure is hyperactivity of the adrenal cortex and excess aldosterone levels, patients also feel the first signs of the disease

In the form of general weakness, pain in the head and heart.

For more information, see – Symptoms of High Blood Pressure

Stages

Also, arterial hypertension has three stages:

• the first stage is recorded at blood pressure readings of 140-159/90-99 mm Hg;
• second stage – blood pressure 160-179/100-109 mm Hg;
• third stage – BP≤180/≤110 mm Hg.

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Forms

In clinical practice, the following types of systolic hypertension are distinguished:

• isolated systolic arterial hypertension - if the systolic blood pressure is more than 140 mm Hg, and the diastolic does not exceed 90 mm Hg;
• unstable or labile systolic arterial hypertension is manifested by a periodic increase in blood pressure (usually no more than 140 mm Hg) at the moment of contraction of the heart muscle. The main causes are associated with excessive release of adrenaline, noradrenaline and dopamine, which provokes an increase in cardiac output into the bloodstream;
• stable systolic arterial hypertension is characterized by constantly elevated systolic blood pressure with a gradation of indicators - 140-159 mm Hg (mild form) and more than 160 mm Hg (moderate form).

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Complications and consequences

The consequences and complications associated with systolic arterial hypertension affect target organs (heart, kidneys, brain, retina, peripheral arteries) and are as follows:

• left ventricular hypertrophy;
• arrhythmia and atrial fibrillation;
• pulmonary hypertension;
• heart failure;
• sclerosis of the cerebral arteries with acute cerebrovascular accident (stroke) or with chronic encephalopathy against the background of insufficient blood supply to brain tissue;
• sclerotic changes in the vessels and parenchyma of the kidneys with chronic renal failure (impaired glomerular filtration);
• deterioration of vision (due to narrowing of the retinal vessels).

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Diagnostics systolic arterial hypertension

Standard diagnostics of systolic arterial hypertension begins with collecting patient complaints and measuring blood pressure using a tonometer, as well as listening to heart sounds using a phonendoscope.

Instrumental diagnostics may include ECG (electrocardiogram), echocardiography (ultrasound of the heart), ultrasound of the kidneys and thyroid gland, X-ray of the arteries (arteriography) and ultrasound examination of vascular blood flow (Dopplerography).

Basic tests: blood test (cholesterol level and glucose content, thyroid hormones, aldosterone, creatinine and urea); general urine analysis.

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Differential diagnosis

Differential diagnosis aims to distinguish systolic hypertension from, for example, white coat syndrome.

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Treatment systolic arterial hypertension

According to recommendations accepted worldwide, the treatment of systolic arterial hypertension includes both non-drug methods and drug therapy. The former include recommendations regarding getting rid of excess weight, quitting smoking, limiting the consumption of table salt, alcoholic beverages, and animal fats. Read more - Diet for high blood pressure. In addition, doctors recommend moving more and taking vitamins.

Drugs used in the treatment of systolic hypertension include:

• diuretics (thiazide and thiazide-like) Hydrochlorothiazide (Hydrothiazide), Clopamide, Indapamide (other trade names: Acripamide, Indap, Indapsan), Torasemide (Triphas).
• drugs that inhibit the action of ACE and block the synthesis of angiotensin II - Enalapril (Enap, Renital, Vazotek, Vasolapril), Captopril, Lisinopril, Monopril, Sinopril;
• calcium antagonists – Diltiazem (Dilatam, Diacordin, Altiazem, Cordiazem), Verapamil, Nifedipine;
• β-blockers with vasodilating action - Labetolol (Abetol, Labetol, Lamitol, Presolol), Pindolol (Visken, Pinadol, Prindolol), Carvedilol (Carvidil, Carvenal, Corvazan, Vedikardol), Nebivolol, Celiprolol;
• renin blockers Aliskiren (Rasilez), Cardosal;
• angiotensin II receptor blockers (angiotensin II inhibitors) – Valsartan, Losartan, etc.;
• vasodilaptors Nepressol (Dihydralazine, Gipopresol, Tonolysin).

The diuretic drug Hydrochlorothiazide is prescribed one or two tablets per day. Possible side effects include dry mouth, thirst, decreased appetite, nausea and vomiting, as well as convulsions, decreased heart rate, decreased potassium levels. This drug is contraindicated in kidney problems, pancreatitis, diabetes, gout and pregnancy.

Tablets for lowering blood pressure Enalapril are taken once a day (0.01-0.02 g). Side effects include dizziness, headache, nausea, diarrhea, and convulsions.

Diltiazem helps to expand the lumen of blood vessels and reduce blood pressure at a daily dose of 180-300 mg, but the drug is contraindicated in patients with heart rhythm disorders and severe cardiac and renal failure, as well as in children and pregnant women.

The drug Labetalol is taken up to three times a day, one tablet (0.1 g); dizziness, headache, nausea, intestinal disorders, and increased fatigue may occur. Labetalol is not prescribed if patients have severe heart failure.

The drug Nepressol - in the absence of atherosclerosis of the cerebral vessels - is recommended to be taken two to three times a day, one tablet (25 mg). The most common side effects include headache and dizziness, tachycardia and heart pain.

The complex drug for lowering blood pressure Captopril contains hydrochlorothiazide and captopril. The usual dosage is 12.5-25 mg (half a tablet and a whole tablet) twice a day. The drug is contraindicated in severe renal failure, aortic stenosis, hyperaldosteronism, hypokalemia and hyponatremia. And side effects can be manifested by urticaria, dry mouth, loss of appetite, nausea, diarrhea, tachycardia, impaired diuresis, etc.

See also - High Blood Pressure Tablets

Homeopathy for this disease: Acidum aceticum D12, Barita muriatica, Magnesium phosphoricum D6, Celsemium, Strontiana carbonica, Arsenicum album.

Physiotherapeutic treatment of isolated systolic arterial hypertension is practiced, the main methods are given in the publication - Physiotherapy for arterial hypertension

And folk treatment, which, as a rule, uses herbal treatment, is described in the material - Herbs that lower blood pressure

Prevention

What measures help prevent high blood pressure are described in detail in the article – Prevention of arterial hypertension

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Forecast

Patients should understand that the prognosis of systolic arterial hypertension, especially its stable form, depends on many factors. First of all, on the degree of increase in blood pressure and the presence of cardiac and cerebral complications.

According to cardiologists, men with this disease (compared to men with normal blood pressure) have an increased risk of death from coronary heart disease of 28%. And for women - almost 40%.

Systolic hypertension and the army

Systolic arterial hypertension of the first or second stage detected in a conscript imposes certain restrictions on his suitability for military service and is registered by military registration and enlistment office doctors in the form of assigning the category - limited fitness. Hypertension of the third stage means unfitness for conscription into the army.

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